What I Learn From You
"Average clinicians use averages."
I was taught that lesson in pharmacy school, and rarely does a day go by that I'm not reminded of its wisdom. The past year has been a big one for those of us who help take care of patients with diabetes. We learned that controlling hyperglycemia (high blood glucose) has limits in terms of its ability to reduce the risk of heart disease. We learned that while aspirin is a wonderful drug, it too has limits in people whose risk of heart disease is already low. We also learned that for those not taking insulin, there may be limits to the ability of home blood glucose monitoring to improve overall blood glucose control. In each of these cases, we're reminded of the important lesson that there is no such thing as the "average" person with diabetes.
When it comes to monitoring blood glucose at home, the patients I see tend to fall into one of a few broad categories. Some test their blood glucose at least once a day, varying the timing each day. Other people just check a morning fasting glucose a few times a week. Others rarely check at all. What the research recently told us for people not taking insulin is that overall, blood glucose control may not predictably differ among these groups of patients when they're studied in a randomized setting.
But those are the average outcomes, and who wants to be average? What I enjoy about my patients who test their blood glucose at varying times throughout the week is that they usually have things to teach me. They come in with questions about why their blood glucose does different things in the morning versus the afternoon. They teach me about how different types of food appear to affect their blood glucose differently and how exercise (or the lack of it) changes their blood glucose. Invariably, patients learn as much or more about their diabetes than I do. They get more motivated about their exercise. They are a little more careful about what they eat. In this way, as we work as a team, every patient becomes his or her own clinical trial. The person who is really doing the work of managing blood glucose in this case is the patient as much as it is a doctor or nurse or pharmacist.
The research and work that I do before seeing patients is mostly about learning what will happen on average when different treatment approaches are used. But patient care is about going beyond average. Rarely do I find home-monitored blood glucose levels to be of little or no value. On the contrary, they usually have a lot to teach both me and my patient. And I never get bored of learning from my patients.